Purpose: To investigate the effectiveness of selective taste steering (STS) to hyper personalize bread and soup for adult cancer outpatients with chemotherapy-induced taste alterations. Methods: This multicentre study included two groups of adult cancer outpatients with CiTA, all receiving dietary advice as standard care. In one group, STS was applied to bread and soups for three months. Outcomes were compared using validated scales and a structured questionnaire at baseline and after one and three months of follow-up. Results: At baseline, 19.3% of all patients (N = 160) had a normal nutritional status. Compared to the intervention group, undernutrition in the control group increased significantly after 1 month (p < .001) and 3 months (p < .001). In the intervention group, the score for 'appetite loss' decreased after 1 month (p < .001) and remained low after 3 months of follow-up (p < .001). The 'fatigue, ' 'nausea/vomiting' and 'diarrhea' symptom scores in the intervention group decreased significantly (p < .001, <.001 and < .002, respectively). Conclusion: STS decreased loss of appetite and improved palatability and food intake as well as food-related symptoms of QOL in adult cancer outpatients with CiTA These findings are clinically relevant and support a hyper-personalized approach to malnutrition in cancer patients.

Purpose: This study aimed to assess whether the application of selective taste steering (STS) to personalize bread and soup recipes had any effect on (1) quality of life, (2) the palatability of these meals, and (3) food intake in patients with chemotherapy-induced taste alterations (CiTA). Methods: This multicentre controlled before-and-after study included two groups of adult cancer outpatients who all experienced CiTA. Both groups received dietary advice as standard care. In one group, STS was applied to bread and soups at home for three months. Both groups were compared using validated scales and a structured questionnaire, at the start of the study and after 1 and 3 months of follow-up. Results: A total of 19.3% of all patients (N=160) had a normal nutritional status (MNA-SF score >11). Compared to that in the intervention group, the number of patients with undernutrition (MNA-SF score <8) in the control group increased after 1 month (p <0.001) and 3 months (p <0.001) of follow-up. Compared to those in the control group, the 'fatigue', 'nausea/vomiting' and ‘diarrhoea’ symptom scores in the intervantion group decreased significantly (p <0.001, <0.001 and 0.002, respectively). In the intervention group, the score for 'appetite loss' decreased after 1 month (p <0.001) and remained low after 3 months of follow-up (p <0.001). Conclusion: STS translates into a significant decrease in the loss of appetite and an increase in palatability and intake of personalized bread and soups. These findings are clinically relevant and support this innovative approach to malnutrition in cancer patients.

The use of texture modified food (TMF) is widely spread in the daily care of patients with oropharyngeal dysphagia (OD). However, TMF have been shown to have a negative impact on the patients’ quality of life. Adherence rates are low, increasing the risk of malnutrition and aspiration in an already vulnerable patient population. The aim of this exploratory study was to gain insight in the feasibility of adding particles to pureed food on tongue strength, swallowing safety and efficiency in patients with OD. Ten adult participants with OD swallowed three different boluses. Bolus 1 consisted of no particles (IDDSI level 4), small and bigger particles were added in bolus 2 and 3. Tongue strength during swallowing (Pswal) was measured using the Iowa Oral Performance Instrument (IOPI). Swallow safety (penetration and aspiration) and swallow efficiency (residu) were quantified during fiberoptic endoscopic evaluation of swallowing by means of the PAS scale and Pooling score. RM Anova and Friedman tests were performed for analyzing the impact of bolus on the outcome parameters. No significant effect of bolus type on Pswal was measured. Neither the PAS nor the Pooling score differed significantly between the three different boluses. Aspiration was never observed during swallowing any bolus with particles. This preliminary study shows that the addition of particles to pureed food had no impact on Pswal, swallowing efficiency or safety in patients with OD. This innovative project is the first step in research to explore the characteristics of TMF beyond bolus volume, viscosity and temperature.

Introduction: Taste changes are common during chemotherapy. Currently, limited evidence-based guidelines exist for the effective management of chemotherapy induced dysgeusia in adult cancer outpatients. In this study, chefs gastro-engineering combine medical and para-medical assessments with innovative insights from gastrological sciences such as selective taste management to improve the taste of bread for cancer outpatients. Method: The oncologists from the participating hospitals referred eligible patients to a chef-led taste center. The chef gastro-engineering carries out a taste assessment and combines these results with the food preferences of the patient as well as any advice of the dietician and/or the speech therapist to develop personalized recipes, in this case a recipe for personalized bread. The patients were asked to bake and consume this personalized bread at home, with the help of their family caregiver. The effects of this innovative self-care intervention were measured after 1 month follow-up. Results: Included patients (N=112) are randomly divided in a bread-baking (intervention) group (N=54) and a control group (N=58). Over 80% of the bread baking patients perceived personalized bread as equally or more tasteful than usual bread despite their stressful chemotherapy-induced dysgeusia. After one month follow-up a significant loss of bodyweight (p .021) and Body Mass Index (p .025) is observed in the control group while in the bread-baking group this loss was not significant (p .968 and p .956 respectively). Only 17% of the bread baking group required some telephone or online assistance in order to correctly apply their personalized recipe. In-depth Interviews with the patients and their caregivers revealed the highly empowering effect of this innovative self-care intervention. In 60% of the cases, the bread was prepared by the family caregiver. Compliance was high and no side effects were reported. Conclusion: A chef-led taste center appears to be able to accurately and safely address the chemotherapy-induced dysgeusia in adult cancer outpatients. Thanks to this integrated and hyper-personalized approach to a stressful side effect of chemotherapy, more than 80% of the participants were able to enjoy tasty bread again despite dysgeusia. Given the positive effect on patient empowerment and since baking personalized bread at home is safe and feasible, this approach should be extended to other meal components. A chef-led taste center should be structurally anchored in the transmural integrated care pathway for adult cancer pati

OBJECTIVE:This study will synthesize the available evidence on the prevalence and incidence of chemotherapy-induced taste alterations in adult cancer patients. INTRODUCTION:Taste and smell alterations in cancer patients due to chemotherapy affect patients' quality of life and can cause malnutrition. Recent knowledge about the incidence and prevalence of chemotherapy-induced taste alterations may enable tailored food interventions for this specific population. Describing variations in taste changes in subgroups of chemotherapy is important to inform taste steering interventions. INCLUSION CRITERIA:The review will consider studies that include adult cancer patients who are receiving or have received chemotherapy as a treatment for an oncologic issue. It will include studies that investigate the prevalence and incidence of chemotherapy-induced taste alterations that have been assessed objectively or subjectively by patient-reported outcomes. METHODS:A systematic search will be performed of the following databases: MEDLINE (PubMed), CINAHL (Ovid), Embase, and OpenSIGLE. Analytical, observational, and cross-sectional studies will be considered. All studies will undergo critical appraisal, data extraction, and synthesis. Data will be extracted using the JBI standardized data extraction tool for prevalence and incidence. Type and frequency of treatment and cytostatic agent will be extracted. The population will be described by age and gender. In addition, study methods and proportions of interest to the review question will be extracted. Pooled prevalence estimates will be calculated using a random effects model. SYSTEMATIC REVIEW:PROSPERO CRD42020136706.

Population aging and declining birth rates are key demographic trends of the 21st century. While the overall life expectancy and healthy life years increase, the quality of life and functional capacity worsens due to non-communicable diseases strongly related to aging. Therefore, aging citizens are often vulnerable to food insecurity. The aim of this paper is to provide insights into the physical accessibility of fresh food and possible alternatives within the setting of an aging society in Antwerp (Belgium), a metropolitan city at the heart of the EU Reference Site ‘Three Rivers Food Delta’. We demonstrate that a large number of the Antwerp suburban areas in which 15 to 25% of current inhabitants are already over 65 years old are confronted with problematic physical accessibility of food due to long walking distances to the nearest food shop. E-commerce has the potential to provide better access to fresh food. This is especially relevant for people with specific needs, such as health-related diets, dysphagia, and/or limited mobility. However, e-commerce introduces new inequalities, as those who would benefit the most from digital accessibility currently use it least. Hence, the organization of fresh food access requires a more thoughtful organization of the ‘last mile’ and possible alternatives to home delivery. This makes food accessibility an urgent factor of concern in public health and healthy aging in the Antwerp suburban areas.

People in need of care, chronic or acute, often present problematic food intake and special nutritional needs. Integrated, person-centred and pro-active food and nutritional care delivery has been proven effective for people in health care. However, skills mismatches have been reported in different professions involved, which also applies to the role of chefs in healthcare. The EU funded project NECTAR aims at closing this gap by creating a new job profile, called Chef Gastro-Engineering (CGE). The current publication summarizes the status quo in hospitals and gives a perspective on the future role of chefs in integrated healthcare delivery.

AIM:Alterations in taste are distressing side effects for cancer patients receiving chemotherapy. The Center for Gastrology (Belgium) developed a self-care intervention based on taste control. This intervention contains an assessment of the individual taste and food hedonics. It provides recipes based on the individual assessed hedonics profile, so patients can self-prepare personalized meals. This study aims to describe the experiences of oncologic patients with the home baking of personalized bread. DESIGN:A qualitative, descriptive design with individual semi-structured interviews was used. METHODS:In August 2018, eleven face-to-face interviews were conducted until data saturation. RESULTS:The analysis of the interviews revealed five major themes: "Stepping out of your role," "Having something positive to do," "gaining insight," "receiving recognition" and "practical limitations."

Background: We aimed to assess taste disturbances in COVID-19 patients. Additionally, we hypothesized that it is possible to establish a reliable and inexpensive screening method for SARS-COV-2 infection using a flavor test. Methods: The ability to taste the sweet, salty, sour and bitter flavors was assessed in 52 COVID-19 patients and 36 controls using flavor tablets (sucrose, NaCl, ascorbic acid and grapefruit extract-99%

Purpose: Taste and smell alterations are known side-effects of an oncological treatment with chemotherapy and can cause reduced food intake and lead to malnutrition and cachexia. ESPEN guidelines state that organizations should foresee a protocol to identify patients at nutritional risk and that screening should be available for all patients. The Chemotherapy-induced Taste alteration Scale (CiTAS) is described as a self -reported scale with a high reliability and validity. The aim of this study is to make a back translation and validation of the Chemotherapy-Induced Taste Alteration Scale in Dutch.Methods: The evaluation instrument was constructed in a three-phased project. First, the Japanese version was backtranslated to Dutch and piloted in a cognitive interview. In a second phase, a Delphi procedure was followed. Context validity and Cronbach’s alpha were calculated. In a third phase comfirmatory analysis was tested.Results and conclusion: The overall Cronbach’s alpha was 0.89. The convergent and discriminant validity show us that the items that should be related indeed are, like the items in the construct and that items that shouldn’t, are not, as between the constructs. The scale was successfully backward translated and validated in Dutch and is ready to be used to screen Dutch speaking cancer patients with chemotherapy as a treatment for their cancer diagnosis. This version of CiTAS can be implemented in the Flemish speaking part of Belgium and in the Netherlands.

Background. Demographic changes have forced communities and people themselves to reshape ageing concepts and approaches and try to develop actions towards active and healthy ageing. In this context, the European Commission launched different private-public partnerships to develop new solutions and answers on questions related to this topic. The European Innovation Partnership on Active and Healthy Ageing, including topic related action groups as well reference sites committed towards a common action to facilitate active and healthy ageing, has contributed key elements for interventions, scaled up best practices and evaluated impact of their action to drive innovation across many regions in Europe over the past years. Methods. This paper describes action taken by A3 action group in the European Innovation Partnership on Active and Healthy Ageing. This paper gives an overview of how the partnership combined the view on frailty coming from public health as well as the clinical management. Results. Within different European regions, to tackle frailty, EIPonAHA partners have conceptualized functional decline and frailty, making use of good practice models working well on community programs. The A3 Group of EIPonAHA has worked alongside a process of innovation, targeting all ageing citizens with the clear goal of involving communities in the preventive approach. Conclusion. Engagement needs of older people with a focus on functionally rather than disease management as primary objective is considered as an overarching concept, also embracing adherence, compliance, empowerment, health literacy, shared decision-making, and activation. Furthermore, training of staff working with ageing people across all sectors needs to be implemented and evaluated in future studies.

PURPOSE Currently, limited evidence-based guidelines exist for the effective management of chemotherapy induced dysgeusia in cancer outpatients. In this pilot study, we used innovative insights from gastrological sciences such as selective taste management to improve the taste of bread for cancer outpatients. We investigated whether it is feasible for cancer outpatients and family caregivers to bake personalized bread themselves at home, whether such bread is considered tasty and if daily consumption of it has any effect on anthropometric measurements. METHODS Included patients (N=112) are randomly divided in a bread-baking group (BBG) (N=54) and a control group (N=58). Their individual taste thresholds profile is assessed using the innovative O-Box. Anthropometrics and structured questionnaires are used to compare the effects of personalized bread after one month follow-up. RESULTS Only 17% of the BBG required some telephone or online assistance to correctly apply the prescribed recipe. In 60% of the cases, the bread was prepared by the family caregiver. Compliance was high and no side effects were observed. Over 80% of the BBG perceived personalized bread as equally or more tasteful despite their stressful taste alterations. Compared to the control group loss of bodyweight and Body Mass Index in the BBG was not significant (p .968 and p .956 respectively). CONCLUSIONS Baking personalized bread at home appeared to be feasible. Selective taste management based on individual taste thresholds profiles should be studied more in depth using whole meals in a larger cancer outpatients population.

Non-communicable chronic diseases (NCCDs) are the main cause of morbidity and mortality globally. Demographic aging has resulted in older populations with more complex healthcare needs. This necessitates a multilevel rethinking of healthcare policies, health education and community support systems with digitalization of technologies playing a central role. The European Innovation Partnership on Active and Healthy Aging (A3) working group focuses on well-being for older adults, with an emphasis on quality of life and healthy aging. A subgroup of A3, including multidisciplinary stakeholders in health care across Europe, focuses on the palliative care (PC) model as a paradigm to be modified to meet the needs of older persons with NCCDs. This development paper delineates the key parameters we identified as critical in creating a public health model of PC directed to the needs of persons with NCCDs. This paradigm shift should affect horizontal components of public health models. Furthermore, our model includes vertical components often neglected, such as nutrition, resilience, well-being and leisure activities. The main enablers identified are information and communication technologies, education and training programs, communities of compassion, twinning activities, promoting research and increasing awareness amongst policymakers. We also identified key 'bottlenecks': inequity of access, insufficient research, inadequate development of advance care planning and a lack of co-creation of relevant technologies and shared decision-making. Rethinking PC within a public health context must focus on developing policies, training and technologies to enhance person-centered quality life for those with NCCD, while ensuring that they and those important to them experience death with dignity.

Background The multitude of negative consequences of nurse burnout calls for interventions to protect the well-being of the individual nurses, patients, and hospital organizations. However, much is still to be discovered about the development of this complex psychological syndrome. Purpose This study aimed to describe the development of nurse burnout for a population of Flemish hospital nurses while considering vulnerability and situational stressors as indicated by the vulnerability-stress model. Methods Ten registered nurses were enlisted for semistructured interviews through purposive sampling. All selected nurses were currently suffering from burnout, showed a burnout risk, or had gone through a burnout in the past. A descriptive thematic analysis was performed with themes inductively emerging from the data. Results Four main themes emerged: “being passionate about doing well or being good,” “teamwork,” “manager,” and “work and personal circumstances.” More specifically, it was the discrepancy between the first individual vulnerability factor and the three situational stressors that led to feelings of stress and burnout. Conclusions The essence of the development of nurse burnout was found in the discrepancy between individual vulnerability and situational stressors. Therefore, we recommend burnout prevention to target both factors.

REVIEW QUESTION/OBJECTIVE:The objective is to systematically review the psychometric properties and the clinical utility of patient-reported outcome measures (PROMs) and proxy-reported outcome measures that assess health-related quality of life (HRQoL) among patients receiving enteral feeding to make recommendations for use in clinical practice and research. The purpose of this systematic review is to evaluate the psychometric properties and the clinical utility of:The research question is: What are the psychometric properties and the clinical utility of these measures? We will summarize evidence on the following properties: validity (content validity, criterion-related validity, construct validity, floor and ceiling effects), reliability (reproducibility and internal consistency) and responsiveness and clinical utility (interpretability and feasibility to complete the PROM and the proxy-reported outcome measure).

Background : With prevalence rates varying from 10 to 60%, malnutrition in acute hospitals has been acknowledged as a persistent problem in older adults worldwide. This publication is to describe the nutritional condition and associated risk factors of malnutrition in free living elderly on admission to the hospital for major elective surgery.Methods : A cross sectional, multi-center study in eight surgical wards in three Belgian hospitals. A total of 204 free living elderly, aged 74.8 +/- 6.6 years (Mean +/- SD), on admission to the hospital for major elective surgery and requiring at least 3 days of hospitalization, were consecutively recruited to the study. The nutritional status was assessed on admission and before surgery using the recommended NRS-2002. Data on possible associated factors were collected during post-operative stay using a structured questionnaire.Results : A total of 107 patients (51.4%) were at high risk of malnutrition. In patients older than 70 years (n 150) the risk of malnutrition increased up to 66%. None of the included patients reported preoperative referral to a dietician or nutritional advice nor any prescribed preoperative nutritional supplement. In a multivariate regression analysis it appeared that none of the possible associated factors were significantly associated with malnutrition.Conclusions : This study confirms the high risk of malnutrition in community living elderly on admission to hospital for elective surgery. According to the NRS-2002 these patients might benefit from nutritional support. However, it appears that nutritional support is not yet commonly implemented in preoperative care for this population at risk.

The story of evidence-based practice in nursing is long, with many successes, contributors, leaders, scientists, and enthusiasts. Nurse educators have great advantages offered from a wide variety of educational resources for evidence-based practice. These resources offer students the opportunity to connect their emerging competencies with clinical needs for best practices in clinical and microsystem changes.

Karel de Grote University College, Antwerp and University of Antwerp, Belgium *Bart is a member of the Cochrane Nursing Care Field (CNCF). Correspondence: Bart Geurden, RN, MSc, Lecturer and Academic Assistant, Karel de Grote University College, Antwerp and University of Antwerp, Belgium. E-mail: [email protected] This is a summary of a Cochrane review. The full citation and the names of the researchers who conducted the review are listed in the section ‘Reference’.

Malnutrition is a known problem in hospitals and nursing homes. This study aims to evaluate the prevalence of being at risk of malnutrition in community living adults receiving homecare nursing and to determine factors independently associated with this risk of malnutrition. Furthermore, it also aimed to describe aspects of current nutritional nursing care. Patients (n = 100) are screened with the Malnutrition Universal Screening Tool to evaluate their risk of malnutrition. A patient survey was used to analyse associated factors. In this population, 29% are at risk for malnutrition. Following a multivariate logistic regression analysis, 'loss of appetite' proved the most important factor. A survey for nurses (n = 61) revealed low awareness, poor knowledge, poor communication between stakeholders and a moderate approach of malnutrition. These findings should encourage homecare nurses to use a recommended screening tool for malnutrition and to actively observe and report loss of appetite to initiate the prescription of individual tailored interventions. Belgian homecare nurses' management does not yet fully comply with international recommendations. Additional training in nutritional nursing care and screening methods for malnutrition is needed. Systematic screening should be further developed and evaluated in this at-risk population.